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From the 1/14/2022 release of VAERS data:

Found 41,515 cases where Vaccine targets COVID-19 (COVID19) and Manufacturer is MODERNA and Serious

Government Disclaimer on use of this data



Case Details

This is page 25 out of 4,152

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VAERS ID: 937569 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-01-02
Onset:2021-01-07
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient reported expired 1/7/2021


VAERS ID: 937579 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2020-12-30
Onset:2020-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Abdominal pain, Acute respiratory distress syndrome, Arteriosclerosis coronary artery, Ascites, Atrial fibrillation, Blood culture negative, Blood lactic acid, Blood potassium decreased, Brain natriuretic peptide normal, C-reactive protein increased, Chronic obstructive pulmonary disease, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Confusional state, Culture urine positive, Diarrhoea, Dyspnoea, Electrocardiogram abnormal, Fall, Haematocrit decreased, Haemoglobin decreased, Hepatic cirrhosis, Hiatus hernia, International normalised ratio increased, Lipase normal, Lung opacity, Myalgia, Nausea, Oedema, Pancreatitis, Platelet count decreased, Portal hypertension, Procalcitonin increased, Pulmonary embolism, Pyrexia, Red blood cell count decreased, Scan with contrast, Sepsis, Sinus tachycardia, Splenic granuloma, Tachycardia, Tachypnoea, Vomiting, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zyprexa 15 mg tablet once daily Levothyroxine 100 mcg tablet once daily Metformin ER 500 mg tablet 2 tablets by mouth twice daily Divalproex DR 240 mg Give 3 tablets by mouth once daily Metoprolol tartrate 50 mg tablet by mouth twice daily
Current Illness: COVID 19 (tested positive on 11/27/2020). Appeared to have recovered, but had some weight loss as well as persistent weakness, activity intolerance.
Preexisting Conditions: Schizophrenia Dementia without behavioral disturbance Personal history of covid-19 (Tested positive on 11/27/2020) Type 2 diabetes mellitus Morbid Obesity Essential Hypertension BPH with LUTS Allergic rhinitis Hypothyroidism Seborrheic dermatitis Fatty liver disease Pancytopenia Glaucoma History of nicotine dependence, cigarettes
Allergies: Ciclopirox- erythema and pruritus Naltrexone- reaction dizziness Topiramate- mood changes
Diagnostic Lab Data: 12/31/2020: WBC 4.8 K/uL ; RBC 4.23 M/Ul; Hgb 12.9 g/dL; Hct 38.6%; Platelets 63 k/uL; Blood culture: No growth; Urine culture: Moderate mixed flora; Lipase 55 U/L; Procalcitonin 2.38 ng/mL; BNP 90; Lactic acid 7.2 mmo/L; CRP 110.5 mg/L; Potassium 3.4 mmol/L; INR 2.4 ; CT Angio Chest: Pulmonary embolism left and right; Moderate pachy peripheral ground glass right infiltrates Heavy triple vessel coronary calcification with heavy left main coronary calcification. Mild inflammatory stranding around the normal appearing pancreatic head suggesting pancreatitis. Moderate thickening of the wall of distal esophagus associate with small hiatal hernia: EKG on 12/31/2020: Sinus tachycardia; EKG on 1/2/2021: Atrial fibrillation with rapid RVR; On 1/3/2021: CT abdomen with contrast liver cirrhosis with portal venous hypertension, multiple splenic granulomata, recanalization of the umbilical vein. Third spacing with body wall edema and mild pericholecystic ascites. The mild stranding in the upper abdominal fat could represent mild pericholecystic ascites. Mostly liquid stool throughout colon without findings of intestinal obstruction.
CDC Split Type:

Write-up: On 12/31/2020, at approximately 00:15, pt developed a fever of 102.9 F and tachycardia with rate of 120. He was treated with acetaminophen. Later in the morning, he complained of nausea, generalized muscle aches, intermittent increase in confusion. At approximately 14:00, he had a fall out of bed and at that time noted to be short of breath, tachypneic. He was taken via ambulance to Emergency Department. From there he was transferred to Hospital for admission with acute respiratory distress, suspected sepsis with lactic acid 7.4 and Bilateral Pulmonary Emboli. He was started on heparin and broad spectrum antibiotics and transitioned to ELIQUIS on 1/3/2021. Infectious etiology of sepsis was unclear. He continued broad spectrum antibiotics with clinical improvement. Abdominal CT scan was obtained due to intermittent nausea, vomiting, abdominal pain, loose stools. His heart rhythm flipped to Atrial Fibrillation with RVR on 1/2 and his rate improved with titration of metoprolol. He was also treated with prednisone for suspected underlying undiagnosed COPD. It is noted in his hospital summary that PEs presumed provoked in the setting of his recent COVID 19 infection. He was discharged from the hospital on 1/8/2021 and readmitted to the Veterans Home. He has been stable.


VAERS ID: 937582 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-01-05
Onset:2021-01-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Influenza virus test negative, Laboratory test normal, SARS-CoV-2 test negative, Vomiting, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: Asthma
Allergies: coconut
Diagnostic Lab Data: Evaluation performed by hospital-unsure of all testing completed but stated that she was negativeX3 for COVID, neg flu, and neg pneumonia.
CDC Split Type:

Write-up: Received Moderna vaccine on 1/5. Had a single episode of vomiting approximately 1 hour after vaccine. Hx of Asthma, started to develop SOB approximately 2 days later. She reached out to PCP and used inhaler with little relief. SOB worsened and she was admitted to the hospital on 1/8/21. Eval was negative for COVID (3 tests completed), flu and pneumonia. She has elevated WBCs and was given steroids and supplemental oxygen. She is improving but remains inpatient.


VAERS ID: 937774 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-05
Onset:2021-01-10
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Pain, Pneumonia, Pyrexia, SARS-CoV-2 test positive, Sepsis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Had Covid + PCR test on 10/06/2020.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever/Cough/Body Aches. Covid +, Pneumonia and Sepsis


VAERS ID: 937818 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-07
Onset:2021-01-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN CAD Stemi with stent placement BPH
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This is being reported because of the incident occurring 2 days after the Moderna Covid-19 vaccination. It was reported that the patient expired on 1/9/21, 2 days after receiving the Moderna vaccine. Upon screening of patient prior to administration on 1/7/21, the patient completed paperwork answering NO to the following "Do you currently have any active infections or acute respiratory illness or fever."


VAERS ID: 938109 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Iowa  
Vaccinated:2020-12-31
Onset:2021-01-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O11J20A / 1 AR / IM

Administered by: Work       Purchased by: ?
Symptoms: COVID-19 pneumonia, Chills, Cough, Headache, Pain, Pyrexia, SARS-CoV-2 test positive, Sinus congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID swab positive 1/1/2021 Hospital admission 1/11/2021 not sure what tests are being performed
CDC Split Type:

Write-up: Received first dose Moderna COVID vaccine on 12/28/2020; on that same day 12/28 he noticed a dry cough; on 1/1/2021 he reported fever, chills, body aches, Headache, sinus congestion. On 1/1/2021 he tested positive for COVID-19, he reported being with a family member on Christmas who had COVID symptoms. On 1/11/2021 he required hospitalization for COVID-19 pneumonia


VAERS ID: 938235 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-01-06
Onset:2021-01-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test normal, Diarrhoea, Electrocardiogram normal, Hot flush, Nausea, Palpitations, Vomiting
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None at the time of vaccination. Up to one month prior the individual had a cold described as coughing and sneezing
Preexisting Conditions: None
Allergies: None, possibly penicillin
Diagnostic Lab Data: Bloodwork and EKG at the hospital on 1/8 both of which were normal.
CDC Split Type:

Write-up: Beginning at 6:30 am on 1/8, two days following vaccination, the individual was driving to work and began to experience nausea while at a traffic light. He pulled over and threw up. Once he got to work he vomited again. He drove to another facility for work and then threw up 3 or 4 more times. He began experiencing hot flashes at this time. He went to the hospital and was seen in the emergency room. He threw up several more times in the ER and stated that his heart was racing and that he had diarrhea. The emergency room gave him medications for the nausea and he stayed there for 2 or 3 hours. He began to feel better and was discharged to home.


VAERS ID: 938256 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-06
Onset:2021-01-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Blood test normal, Burning sensation, Chest X-ray normal, Dizziness, Electrocardiogram normal, Fatigue, Gait disturbance, Headache, Immediate post-injection reaction, Pain, Syncope, Ultrasound scan normal
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vyvanse 40mg daily took that morning. mvi and calcium 600mg OTC. Generic Voltaran 1% gel apply once a day.
Current Illness: none
Preexisting Conditions: Takes medications for weight loss Chronic neck and right shoulder pain
Allergies: Penicillin, erythromycin.
Diagnostic Lab Data: When to ER 1/8/2021- treated and release that day. Dx Syncope. States felt worse after discharge. ultrasound over injections site, blood work, ECG and CXR- everything normal. took Tylenol and Motrin.
CDC Split Type:

Write-up: Immediately developed intense burning that progressed over the next 30 minutes and continued to burn for 3 days. The next day progressive extreme fatigue last 4 days. felt like it was going to pass out. full on body pain, dizzy and lightheaded. need assistance to get to the walk, intense headache.


VAERS ID: 938258 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2020-12-26
Onset:2020-12-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Aspirin, barbiturates, NSAIDs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Very large, reddened, tender area at injection site (like the size of an angry red egg), and fever of 103.2.


VAERS ID: 938310 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Colorado  
Vaccinated:2020-12-31
Onset:2021-01-10
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Acoustic stimulation tests abnormal, Deafness unilateral, Sudden hearing loss, Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine
Current Illness:
Preexisting Conditions:
Allergies: Latex
Diagnostic Lab Data: Hearing test showed significant loss od hearing in right ear
CDC Split Type:

Write-up: Sudden hearing loss right ear accompanied by tinnitus


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